Development of Modic Changes After Percutaneous Endoscopic Transforaminal Lumbar Discectomy: From Risk Analysis to Prediction Modeling.

IF 2.5 3区 医学 Q2 CLINICAL NEUROLOGY
Journal of Pain Research Pub Date : 2024-12-17 eCollection Date: 2024-01-01 DOI:10.2147/JPR.S475650
Lei Li, Chao Wang, Hao Zhang, Antao Lin, Changpeng Qu, Yihao Sun, Hao Tao, Xuexiao Ma
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引用次数: 0

Abstract

Objective: This study examines the occurrence of Modic changes (MC) within the first year following percutaneous endoscopic transforaminal lumbar discectomy (PETD) and investigates associated risk factors.

Methods: This study adopted a retrospective cohort design. Between January 2019 and June 2023, 538 patients diagnosed with single-level lumbar disc herniation and treated with PETD were included. The patients were divided into a training set and a validation set based on their surgery dates. Preoperative radiographic parameters and perioperative indicators were evaluated. Univariate analysis examined risk factors for postoperative MC. Gender-specific subgroups were analyzed. Binary logistic regression developed a predictive model for postoperative MC, assessed using ROC, calibration, and decision curves.

Results: The incidence of MC at one year after PETD was 24.8%. Logistic regression identified 8 significant risk factors for MC after PELD: longer symptom duration, proximity of herniated segment to sacrum, severe disc degeneration, reduced disc height, greater vertebral endplate concavity angle, segmental instability, and lumbar-sacral fusion. Menopause and herniation type were identified as female-specific risk factors. In males, total cholesterol levels were additionally found to be a risk factor for postoperative MC. The male and female subgroup models exhibited satisfactory performance across ROC analysis, calibration plots, and decision curve analysis. Specifically, for male patients, the area under the curve (AUC) was 0.831 for the training set and 0.820 for the validation set; for female patients, the AUC was 0.911 for the training set and 0.868 for the validation set. A nomogram was developed to visualize the model.

Conclusion: This study explored the relevant risk factors of MC after PETD and visualized the prediction model by nomogram, which is beneficial to optimize the surgical scheme of PETD to improve the clinical efficacy.

经皮内窥镜下经椎间孔腰椎间盘切除术后改变的发展:从风险分析到预测模型。
目的:本研究探讨经皮内窥镜下经椎间孔腰椎间盘切除术(PETD)后一年内Modic改变(MC)的发生情况,并探讨相关危险因素。方法:采用回顾性队列设计。在2019年1月至2023年6月期间,538名诊断为单节段腰椎间盘突出并接受PETD治疗的患者被纳入研究。根据患者的手术日期将患者分为训练集和验证集。评估术前影像学参数及围手术期指标。单因素分析检查术后MC的危险因素,并对性别亚组进行分析。二元逻辑回归建立了术后MC的预测模型,使用ROC、校准和决策曲线进行评估。结果:术后1年MC发生率为24.8%。Logistic回归确定了PELD后MC的8个显著危险因素:症状持续时间较长、突出节段靠近骶骨、严重的椎间盘退变、椎间盘高度降低、椎终板凹角较大、节段不稳定和腰骶融合。绝经期和疝类型被确定为女性特有的危险因素。在男性中,总胆固醇水平也被发现是术后MC的一个危险因素。男性和女性亚组模型在ROC分析、校准图和决策曲线分析中表现出令人满意的性能。具体而言,对于男性患者,训练集的曲线下面积(AUC)为0.831,验证集为0.820;对于女性患者,训练集AUC为0.911,验证集AUC为0.868。为了使模型可视化,绘制了一张图。结论:本研究探讨了PETD术后MC的相关危险因素,并通过nomogram可视化预测模型,有利于优化PETD手术方案,提高临床疗效。
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来源期刊
Journal of Pain Research
Journal of Pain Research CLINICAL NEUROLOGY-
CiteScore
4.50
自引率
3.70%
发文量
411
审稿时长
16 weeks
期刊介绍: Journal of Pain Research is an international, peer-reviewed, open access journal that welcomes laboratory and clinical findings in the fields of pain research and the prevention and management of pain. Original research, reviews, symposium reports, hypothesis formation and commentaries are all considered for publication. Additionally, the journal now welcomes the submission of pain-policy-related editorials and commentaries, particularly in regard to ethical, regulatory, forensic, and other legal issues in pain medicine, and to the education of pain practitioners and researchers.
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